University of Southern California, Chan Division of Occupational Science and Occupational Therapy, Los Angeles, CA, United States of America; Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, United States of America; Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States of America.
Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States of America; Seattle Children's Hospital, Seattle, WA, United States of America.
Early Hum Dev. 2020 Jul;146:105057. doi: 10.1016/j.earlhumdev.2020.105057. Epub 2020 May 7.
To determine 1) the relationship between infant medical factors and early neurobehavior, and 2) the relationship between early neurobehavior at 30 weeks postmenstrual age (PMA) and neurobehavior at term equivalent age.
In this prospective longitudinal study, 88 very preterm infants born ≤30 weeks estimated gestational age (EGA) had neurobehavioral assessments at 30 weeks PMA using the Premie-Neuro and at term equivalent age using the NICU Network Neurobehavioral Scale (NNNS) and Hammersmith Neonatal Neurological Evaluation (HNNE).
Lower Premie-Neuro scores at 30 weeks PMA were related to being more immature at birth (p = 0.01; β = 3.87); the presence of patent ductus arteriosus (PDA; p < 0.01; β = -16.50) and cerebral injury (p < 0.01; β = -20.46); and prolonged exposure to oxygen therapy (p < 0.01; β = -0.01), endotracheal intubation (p < 0.01; β = -0.23), and total parenteral nutrition (p < 0.01; β = -0.35). After controlling for EGA, PDA, and number of days of endotracheal intubation, lower Premie-Neuro scores at 30 weeks PMA were independently related to lower total HNNE scores at term (p < 0.01; β = 0.12) and worse outcome on the NNNS with poorer quality of movement (p < 0.01; β = 0.02) and more stress (p < 0.01; ß = -0.004), asymmetry (p = 0.01; β = -0.04), excitability (p < 0.01; β = -0.05) and suboptimal reflexes (p < 0.01; ß = -0.06).
Medical factors were associated with early neurobehavioral performance at 30 weeks PMA. Early neurobehavior at 30 weeks PMA was a good marker of adverse neurobehavior at NICU discharge.
确定 1）婴儿医学因素与早期神经行为之间的关系，以及 2）30 孕周（PMA）时早期神经行为与胎龄相当的神经行为之间的关系。
在这项前瞻性纵向研究中，88 名出生胎龄≤30 周的极早产儿在 30 周 PMA 时使用 Preemie-Neuro 进行神经行为评估，在胎龄相当的足月时使用新生儿重症监护病房网络神经行为量表（NNNS）和哈默史密斯新生儿神经评估（HNNE）进行神经行为评估。
30 周 PMA 时较低的 Preemie-Neuro 评分与出生时更不成熟有关（p=0.01；β=3.87）；动脉导管未闭（PDA；p<0.01；β=-16.50）和脑损伤（p<0.01；β=-20.46）的存在；以及长时间接受氧疗（p<0.01；β=-0.01）、气管内插管（p<0.01；β=-0.23）和全胃肠外营养（p<0.01；β=-0.35）。在控制胎龄、PDA 和气管内插管天数后，30 周 PMA 时较低的 Preemie-Neuro 评分与胎龄相当的足月时较低的总 HNNE 评分独立相关（p<0.01；β=0.12），NNNS 上的结果较差，运动质量较差（p<0.01；β=0.02）和更多压力（p<0.01；β=-0.004）、不对称（p=0.01；β=-0.04）、兴奋性（p<0.01；β=-0.05）和反射不充分（p<0.01；β=-0.06）。
医学因素与 30 周 PMA 时的早期神经行为表现有关。30 周 PMA 时的早期神经行为是新生儿重症监护病房出院时不良神经行为的良好标志物。
